[Editors Note: Addiction Inbox has not covered the so-called behavioral or non-traditional addictions--Internet addiction, video game addiction, compulsive shopping and compulsive gambling--because I am not yet convinced that such behaviors show the same chemical and often inheritable propensities associated with alcoholism and other drug addictions. From time to time, however, I offer up an alternative view. Today’s post is from Joe O'Connor, Director of Communications for Cognitive Therapy Associates, New York City.] --Dirk Hanson
By Joe O’Connor
In 2007, the American Psychological Association reviewed video game addiction for entry into the Diagnostic and Statistical Manual for Mental Disorders. They concluded that there was not sufficient evidence to prove that gaming was an addiction. Similar to Internet Addiction Disorder, the overriding factor in the rejection was that video game overuse acted as an outlet for people with pre-existing mental disorders. Video games – and specifically online games – possess many characteristics of substance dependence and should be recognized as an official addiction.
To say that online video games have grown in popularity over the last decade would be the understatement of the century. Millions of gamers spend hundreds of hours every week playing video games over the Internet. The most popular style of online gaming is the Massively Multiplayer Online games, specifically the Role Playing Games (better known as an MMORPG). Among the more popular titles in this genre are World of Warcraft, Everquest, and GuildWars. These games generally function the same, so the affects that they have on a gamer are similar no matter which game is being played.
While the American Psychiatric Association has rejected the inclusion of IAD and video game addiction from the DSM, gaming should absolutely be recognized as an official addiction. According to the DSM, for substance dependence to occur one or more of these symptoms must be present:
1. Substance abuse 2. Continuation of use despite related problems 3. Increase in tolerance 4. Withdrawal symptoms
All four of these factors are relevant when it comes to online gaming. Many gamers, especially those who play MMORPGs, can attest to the increase in tolerance and withdrawal symptoms. Substance abuse, as defined by the DSM, is also applicable to this issue.
According to the DSM, substance abuse occurs when one or more of these factors take place: (1) recurrent use interferes with school/work/home obligations; (2) recurrent use in physically hazardous situations; (3) legal problems resulting from use; or (4) continued use despite social or interpersonal problems which were originally caused by the addiction.
Two of these factors are definitely in play for gaming. There are many gamers who skirt off work, school, or relationships to play video games instead. This article gives first-hand accounts of people who are addicted themselves, or know someone who is addicted, to World of Warcraft (the most popular MMORPG). These testimonies expose the potentially harmful nature of online gaming and how it can interfere with real world obligations and relationships.
Another aspect which was evident in these testimonies was the difficulty of quitting. Two of the gamers said that they had tried to quit playing, but eventually came back and got hooked on the game again. Withdrawal symptoms were also clearly present. One of the gamers claimed that playing the game was “all [he] thought about.”
The most dangerous aspect of these games, though, may be how easily and quickly a gamers' tolerance can rise. These games are engineered so they become more time consuming as the player progresses. MMORPGs are open-ended as well, meaning there is no opportunity for a player to win the game. The appeal of these games is to watch your character grow. As a character fights through the game, it builds experience, and as it gains experience, grows to higher levels. As the character achieves higher levels, new items and abilities are unlocked. An increase in tolerance stems from the fact that the higher level a character is, the more experience, and time, it takes to achieve the next growth level.
Clearly MMORPG's adhere to all of the attributes of substance dependence. Substance abuse, continuation of use despite related problems, increase in tolerance, and withdrawal symptoms are all present. But even with all of this evidence, gaming was denied its place in the DSM. There are two reasons why gaming has yet to be deemed an addictive disorder, though. First, it is fairly new and more research is required to completely understand the disease. Second, and more disturbing, is the fact that this addiction receives very little public attention.
The vast majority of video game related news focuses on in-game content. There has been an outcry from parents in recent years over the severe violence, language, and sexual content of video games. Gaming addiction has always remained in the shadow of this issue. While monitoring the content of games is important, studies have shown that there is little correlation between the behavior in children and the video games that they play. The evidence shows that video game addiction has more scientific data to support it, with more substantial studies on the way. Also, if we can find ways to treat an addicted gamer it would help in stopping kids from spending too much time playing these violent games.
There is no question that gamers experience symptoms of substance dependence. Also, like many recognized addictions, there is a major problem in diagnosing the condition. Like pathological gambling, gaming addiction does not take a noticeable physical toll. The affect of the disorder is completely behavioral which makes it much harder to diagnose the addict from a more intense gamer who has the ability to quit.
Dr. Allison Conner, a cognitive behavioral therapist, recognizes Internet addiction – including gaming – as a serious psychological issue. She believes this addiction could result in a patient's “retreat from real-life face-to-face relationships.” The more a gamer shies away from real human relationships, the more likely they are to become increasingly dependent on their virtual ones, thereby compounding the problem. Dr. Conner added: “video game addiction may eventually be recognized as a specific classification among other mental disorders.”
Although the physical dangers of gaming are minuscule, there are a myriad of examples of social and behavioral damage directly caused by video game overuse. Addiction clinics all over the world have begun to open their doors to gamers. I think that it is time that the rest of the psychiatric community do the same.